Application for Grand Lodge Officer (2018 – 2020)

This form is to be completed by the candidate for Grand Lodge Appointment. Please respond to all questions. Feel free to attach (upload) a file containing your Masonic Resume, narrative, or other information to this form.

*indicates required field

DISTRICT (determines to whom email will be sent)*

Name:*

Lodge Name & Number:*

Grand Lodge Number:*

Home Address:*

City / State / ZIP:*

Home Phone:

Mobile Phone:

Occupation:*

Company Name and Full Business Address (if applicable):

Business Phone (if applicable):

Email Address:*

Lady's Name:

Year(s) Served as Master and for what Lodge (one per line):*

List your record of Lodge Service (committee chaired, programs or community projects where you were the Team Leader)